760 Single Centre Evaluation of the Risk of Bleeding Following Cutaneous Skin Surgery in Patients with Long-Term Antithrombotic Drugs

Abstract

Abstract Aim The peri-operative management of antithrombotic drugs for skin surgery remains heterogenous with varying practice regarding the interruption of these drugs. This audit aimed to evaluate the risk of bleeding following cutaneous surgery in line with the British Society for Dermatological Surgery (BSDS) guidance on antithrombotic and skin surgery. Method All patients undergoing cutaneous surgery in a single centre were identified following a retrospective review of electronic health records between September to October 2022. Patients were included if they were on antithrombotic therapy in the operative period. Data were collected on demographics, operation type and site, reconstruction, antithrombotic agent and post-operative complications. The primary outcome was the rate of postoperative bleeding. Secondary outcomes included post-operative infection rate, bleeding risk of the cutaneous procedure and other surgical complications. Results This audit included a total of 71 patients who underwent surgery while on antithrombotic drugs, with 55, 12 and 4 procedures being determined as low-, moderate- and high-risk as per the BSDS classification. Of all patients, 8.5% experienced bleeding as a post-operative complication and 50% of these patients were on direct oral anticoagulants (DOACs). In moderate- and high-risk procedures, 37.5% of patients experienced either bleeding or infection. Conclusions Patients on antithrombotic drugs undergoing cutaneous skin surgery may be at an increased risk of post-operative bleeding and infection. Patients who are due to undergo moderate to high-risk cutaneous surgery and are established on DOACs or potent antiplatelet drugs should have these agents paused prior to surgery in an effort to minimise complications.